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INTRODUCTION

Planning a Family is an inevitable moral responsibility. One of


the basically highly intimate and important part of human life is
to produce sensible, reasonable decision within a climate of
freedom and love.
WHO defines Family Planning as A way of thinking and living,
that is adapted voluntarily upon the basis of knowledge,
attitudes and responsible attitudes and decisions by
individuals and couples in order to promote health and welfare
of the family group.

The integral family planning must therefore concern itself and


consider the health and the welfare of the individual member,
so that they will be able to carry out individually the mission
and perform their task as family.
We therefore define the ideal family planning method as one
of which is best for the individual couple with regard to their
environment:
a. physical
c. cultural

b. mental
d. spiritual

Methods of Family Planning (or birth control)


I.

Fertility Awareness-Based Methods


1. Billings Ovulation Method
2. Basal Body Temperature Method
3. Sympto-thermal Method
4. The Two-Day Method
5. The Standard Days Method
II. Lactational Amenorrhea Method
III. Low-Dose Combined Oral Contraceptives
IV. Progestin-Only Pills
V. Progestin-Only Injectables
VI. Combined Injectable Contraceptives
VII. Subdermal Implants
VIII.Intrauterine Device
IX. The Barrier Methods
X. Male Voluntary Surgical Contraception
XI. Female Voluntary Surgical Contraception

I. Fertility Awareness-Based Methods:


This technique is used to identify the fertile phase of the
menstrual cycle, and then to abstain from sexual
intercourse, include:

BBT (Basal Body Temperature)


BOM (Billings Ovulation Method)
STM (Sympto-thermal Method)
SDM (Standard Days Method)
TDM (Two-Day Method)
I.a. Billings Ovulation (Cervical Mucus) Method
The observation of wet and dry sensations in the
vulva.
Fertile period feeling of wetness, and presence of
mucus secretion which is wet, slippery, and clear.

Perfect use: 97%


Typical use: 80%
Women with the following conditions can not use the method:
irregular menstrual cycle
vaginal bleeding between periods
heavy or long monthly bleeding
recently gave birth or had a miscarriage
exclusive breastfeeding
infections or diseases that may change
cervical mucus (e.g. STIs, PID)
taking drugs that affect cervical mucus
(e.g. lithium, TCA, anti-anxiety drugs)
Possible Side Effects and Complications
There are no medical side effects associated
with this method.

I.b. Basal Body Temperature Method


Identifying the fertile and infertile period of a womans cycle
by daily taking and recording of the rise in body temperature
during and after ovulation.
Perfect use: 99%
Typical use: 80%
This method can be used by any woman of reproductive age
who is willing to take and chart her BBT daily and practice
abstinence during fertile period.
Possible Side Effects and Complications
There are no medical side effects or complications
associated with the use of this method.

There are no medical precautions against the use of BBT.


However, the following conditions can affect BBT: sore
throat, colds and flu, fever, toothache, vomiting, diarrhea,
anxiety, sunburn, medication, travel, sleep disturbance, and
alcoholic beverages.
I.c. Sympto-thermal Method
Perfect use: 98%
Typical use: 80%
I.d. The Two-Day Method
This method involves the following:

cervical secretions as an indicator of fertility;


and
women checking the presence of secretions
every day

It has been known before for several decades that secretions


are a very reliable indicator of fertility (this is also what the
Billings Ovulation Method is based on).
Perfect use: 96.5%
Typical use: 86%
This method can be use by:
women with cycles of any length
women with normal secretions
women willing to check their secretions
couples who can avoid intercourse for days

I.e. The Standard Days Method


This is a new method of natural family planning in which all
users with menstrual cycles between 26 and 32 days are
counseled to abstain from sexual intercourse on days 8-19
to avoid pregnancy. The couple uses a device, the colorcoded cycle beads, to mark the fertile and infertile days of
the menstrual cycle.
Perfect use: 95%
Typical use: 88%
This method works well for women who usually have
menstrual cycles between 26 and 32 days long.
Women with cycles not within 26-32 days can not
use this method.
There are absolutely no physical side effects.

II. Lactational Amenorrhea Method:


The use of breastfeeding as a temporary introductory
postpartum method of postponing pregnancy based on
physiological infertility experienced by breastfeeding women.
Perfect use: 99.5%
Typical use: 98%
The normal physiology of breastfeeding and the hormonal
response of a womans body to her infants suckling at her
breast suppresses ovulation.

Disadvantages of using this method


short-term family planning method (maximum 6 months)
Mother works outside of home extended period of
separation
Breastfeeding difficult to maintain for up to 6 months
Any woman can start this method at any time if she meets the
following conditions required for using the method:
1. Full (100%) or nearly (85%) feeding of the baby with breast
milk, day and night
2. The mothers menstrual period has not returned
3. The baby is less than 6 months.

III. Low-Dose Combined Oral Contraceptives:


Pill preparations that contain hormones similar to the
womans natural hormones estrogen and progesterone
taken daily to prevent conception.
The most commonly used and readily available are:
Monophasic low-dose COCs
Biphasics low-dose COCs
Triphasics low-dose COCs
Monophasic Preparations (Brand names)
Logentrol
Marvelon
Microgynon
Nordette
Yasmin

Lady
Meliane
Minulet
Rigevidon

Gynera
Micropil
Mercilon
Trust Pill

Biphasic Preparations (Brand names)


Gracial
Triphasic Preparations (Brand names)
Trinordiol

Triquilar

Logynon

Perfect use: 99.7%


Typical use: 92%
Combined low-dose pills work mainly by suppressing
ovulation or the release of an egg from the ovary as
such pregnancy can not occur.
It makes the cervical mucus thick and inhospitable
to sperm, discouraging entry to the uterus.
It causes changes in the endometrium and reduction
in sperm transport in the fallopian tube.

Advantages of using the method

Safe as proven by studies


Convenient and easy to use
Makes menstrual cycles more regular and predictable
Reduces symptoms of gynecologic conditions
Reduces risk of ovarian and endometrial cancer
Reversible, rapid return to fertility once discontinued
Does not interfere with intercourse

Disadvantages of using the method

Has side effects


Offers no protection against STDs and HIV
Require regular resupply
Can suppress lactation
Other delivery systems
1. Transdermal contraceptive patch
2. Vaginal ring

IV. Progestin-Only Pills:


An oral contraceptive that contains progestin only in lower
doses. (e.g. Exluton and Cerazette)
Perfect use: 99.5%
Typical use: 99%
Mainly thickens the cervical mucus, thus inhibiting sperm
penetration
Advantages of using the method

Can be used by breastfeeding mothers 6


weeks after childbirth
Less risk of related side effects
May help prevent benign breast disease,
endometrial and ovarian cancer, and PID

V. Progestin-Only Injectables:
Injectable contraceptives containing the synthetic hormone
progestin administered by deep IM injection. (e.g. DMPA or
Depo-Provera and Noristerat)
Perfect use: 99.7%
Typical use: 97%
Advantages of using the method

No need for daily intake


No interference to sexual contact

No estrogen related side effects


Does not affect breastfeeding
Help prevent iron deficiency anemia
Make seizure less frequent in women with
epilepsy
Prevents endometrial cancer

Disadvantages & side effects of using the method

Requires injections every 2 or 3 months


Does not protect against STD/AIDS
Menstrual irregularity during the first few months of use
Amenorrhea; some women get anxious if no menses

VI. Combined Injectable Contraceptives:


These are monthly injectable preparations containing a shortacting natural estrogen and a long-acting progesterone that
are given intramuscularly, which are slowly released over a
period of 28 days. (e.g. Cyclofem and Mesigyna)
Perfect use: 99.9%
Typical use: 97%
Not yet available in the Philippines as to date.

Disadvantages of using the method


Can delay return to fertility
Serious side effect like cardiovascular diseases are
possible
Does not protect against STDs
User must return for injection every 30 days
A woman using this method has to have an injection of one vial
of the drug monthly.
Common side effects
Amenorrhea
Weight gain
Mild headaches

Vaginal bleeding/spotting
Dizziness

The Different Oral Contraceptive Pills

VII. Subdermal Implants:


Progestin-only implants inserted under the skin in the
womans upper arm or forearm through a minor surgical
procedure under local anesthesia, which releases progestin
at a controlled rate, thus providing very small doses to
achieve the desired contraceptive effect. (e.g. Norplant,
Jadelle, & Implanon)
Perfect use: 99.9%
Typical use: 99.5%
Advantages of using the method

Reversible
Does not require daily intake
Does not interfere with intercourse
Effective within 24 hours after insertion
No estrogen-related side effects

Advantages of using the method


Does not affect breastfeeding
Helps prevent iron deficiency anemia
Helps reduce endometrial cancer
Disadvantages of using the method

Requires minor surgical procedure


Discomfort may be present following surgery
Need to remove capsule after certain period
Initial cost is high
No protection against STDs
More difficult to remove than to insert

Subdermal Implant

VIII. Intrauterine Devices:


A small plastic or metal device inserted into the womans
uterus to prevent pregnancy. It releases copper or a
hormone. Almost all IUDs have one or two strings, or nylon
threads tied to the plastic frame. The strings hang through
the cervical opening into the vagina.
The TCu 380A, an IUD being used in the Philippines. It is a
T-shaped plastic device with a coil of copper wrapped
around its stem and copper bands on the arms. It is
effective for 10 years.
Hormone-releasing IUDs which are made of plastic
that steadily release small amounts of progesterone
(e.g. Mirena) which is effective for 5 years.

Perfect use: 99.4%


Typical use: 99.2%
Advantages of using IUD

Local action
No effect on amount or quality of breast milk
Low cost
One time application
Return to fertility upon removal
Can be inserted after childbirth or after abortion
Easily removed or inserted by a trained provider
Long-lasting method
Disadvantages and side effects of using IUD
Pain and cramping
Longer and heavier menstrual bleeding
Menstrual irregularities

Disadvantages and side effects of using IUD

Device may be expelled without knowing it


Requires a pelvic exam to insert IUD
Requires a trained service provider
Does not protect against STDs
Requires self-checking of IUD strings from time to time

The TCu 380A IUD prevents pregnancy by a combination of


mechanisms of action, including:
a. Inhibition of fertilization
b. Inhibition of sperm transport into the upper
genital tract; and
c. Inhibition of ovum transport

Adverse Effects and Potential Complications


1.
2.
3.
4.
5.
6.

Prolonged or heavy bleeding


Cramping
Missing strings
Pregnancy with IUD
Pelvic inflammatory disease
Uterine perforation

The Intrauterine System (IUS)


A contraceptive device similar to an IUD but it
contains hormone levonorgestrel (LNG) which is
released into the uterus. It is a plastic T-shaped frame
wherein the stem of the T has a tiny reservoir
containing the hormone LNG. IUS is used for the
management of heavy or prolonged menstrual periods
with no known cause.

Perfect use: 99.9%


Typical use: 99.9%
Disadvantages and side effects of using IUS
Needs to be inserted by a trained provider
Has higher risk of ectopic pregnancy when it
fails
When is the IUS inserted?

Usually within the week of beginning a period


Six weeks after delivery
After an abortion or miscarriage if there is no infection
Anytime once you are certain that the woman is not
pregnant

Possible side effects of IUS


Headache
Nausea
Back pain
Vaginitis
PID

Changes in mood
Depression
Weight gain
Alopecia
Breast pain
Fluid retention
Vaginal dischrage
Skin disorders
Benign Breast Condition

Lower abdominal pain


Change in menstrual bleeding
Cysts formation in the ovaries

The Intrauterine Device

IX. Barrier Methods:


Devices that mechanically or chemically hinder or prevent
the union of the egg cell and the sperm cell (fertilization).
The methods include the following:
1.
2.
3.
4.
5.

Male condom
Female condom
Diaphragm
Cervical cap
Spermicides (gel, foam, tablet or cream)
MALE Condom
A thin sheath of latex rubber made to fit on a
mans erect penis to prevent the passage of sperm
cells and STD organisms into the vagina. Some
are coated with a lubricant or with spermicides.

Perfect use: 98%


Typical use: 85%
Advantages of using the method

Safe and has no hormonal effect


Protects against microorganisms causing STDs/HIV
Encourages male participation in family planning
Easily accessible
Is use in managing premature ejaculation

Disadvantages & side effects of using the method

May cause allergy for people sensitive to latex or


lubricant
May decrease sensation, making sex less enjoyable
for either partner
Interrupts the sexual act
Requires a mans cooperation
Possibility of ripping or slippage during sexual act
Embarrassment to buy or ask partner to use
condom

The MALE Condom

FEMALE Condom
A thin sheath made of soft transparent polyurethane
plastic. It has 2 flexible rings.
Perfect use: 95%
Typical use: 79%
Advantages of using the method
Does not alter the milk production of a breastfeeding
woman
No allergic reaction reported plastic not rubber
Use of this method is under the control of the woman

The FEMALE Condom

Disadvantages & side effects of using the method


It is not yet locally marketed
It is expensive and can be used just once
A woman must touch her genitals in inserting the
condom
The Diaphragm
A small dome-shaped soft rubber cup with a flexible rim
that goes inside the vagina over the cervix. It is fitted by a
trained clinician and used with a spermicidal jelly or
cream which serves as a lubricant.
Perfect use: 94%
Typical use: 84%

Types/Kinds of Diaphragm

How does the method work?

It blocks the sperm from entering the cervix to the


uterus
It also acts as a device holding the spermicidal cream
or jelly against the cervix that can immobilize or kill the
sperm cells

The Cervical Cap


A cap-shaped device (a miniature diaphragm with a tall
dome) made of soft rubber that fits over the cervix and is
held in place at least partially by suction between its firm
flexible rim and the surface of the cervix as the upper
vaginal wall.
Perfect use: 74% (parous women)
Typical use: 68% (parous women)

Disadvantages & side effects of using the method


May be less effective for a woman who had given birth
recently due to size of the cervix
Needs to be used always with spermicides
Should be washed with soap and clean water and
requires careful storage
Higher risk of failure in parous women than among
nulliparous women
Needs initial fitting by trained provider
Needs pelvic manipulation in fitting or positioning the cap

Types/Kinds of Cervical Cap

SPERMICIDES
Vaginal spermicides are made of an inert base and chemicals
which the woman places in her vagina shortly before sex or
before the penis touches the vagina.
Perfect use: 82%
Typical use: 71%
Advantages of using the method
Can be used and stopped any time
Safe and easy to use with just little practice
Can be used as early as 15 minutes before
sex to avoid interruption
May increase vaginal lubrication

Disadvantages & side effects of using the method


Can cause irritation and allergy
Risk of urinary tract infection
Interrupts sex if not inserted beforehand
May be messy
For melting-type spermicides, a waiting period of at
least 10 minutes but not more than 1 hour is needed
before spermicidal effects take place
May cause a warm sensation

X. Vasectomy (Surgical Contraception):


A permanent method for men, wherein the vas deferens is tied
and cut or blocked through a small opening on the scrotal skin.
Perfect use: 99.9%
Typical use: 99.8%
Advantages of using the method

Very effective
Permanent, safe, simple
Can be performed in a clinic, office
No resupplies or repeated clinic visits
No apparent long-term health risks
Man will not lose his sexual ability, erection, and
ejaculation
Does not affect male hormonal function
May increase the couples sexual drive & enjoyment

Disadvantages & side effects of using the method

May be uncomfortable due to slight pain and swelling 2-3


days after the procedure
Reversibility is difficult and expensive
Bleeding may result to hematoma in the scrotum
It can only be done by a trained health provider
The tubes may recanalize (rare & unusual)
Provides no protection against STIs/HIV

Potential Complications & Adverse Effects


1.
2.
3.
4.

Scrotal Hematoma
Wound Infection (including abscess)
Epididymitis
Sperm Granuloma (Seminoma)

Reversal of the procedure is not guaranteed.

Male Surgical Procedure

XI. Bilateral Tubal Ligation (Surgical Contraception):


Involves cutting or blocking the two fallopian tubes.
Perfect use: 99.5%
Typical use: 99.5%
Advantages of using the method
lifelong, safe, and very effective contraception
No supplies needed & no repeated clinic visits
required
Does not interfere with sex
Does not affect a womans ability to have sex
May increased sexual enjoyment no worry about
pregnancy
No effect on breastfeeding
No known long-term side effects or health risks
Can be performed after giving birth

Disadvantages & side effects of using the method


Infection or bleeding at the incision site (uncommon)
Injury to internal organs (uncommon)
Anesthesia risk (uncommon)
If pregnancy occurs (rare), more likely it is ectopic
Requires physical exam by a trained provider
Requires an operating room setup
Permanent reversal is difficult, expensive, and not
available in most areas
No protection against STIs/HIV

Potential Complications & Adverse Effects

Infection
Bleeding
Intestinal injury
Abscess formation

Bilateral Tubal Ligation